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Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score–matched comparative study

Published:March 02, 2022DOI:https://doi.org/10.1016/j.gie.2022.02.050

      Background and Aims

      Endoscopic bariatric therapies are less-invasive alternatives to bariatric surgery, and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety, and comorbidity resolution of ESG compared with laparoscopic sleeve gastrectomy (LSG).

      Methods

      This was a propensity score–matched study of patients who underwent ESG or LSG. Primary outcome was weight loss at 6, 12, 24, and 36 months. A noninferiority margin of 10% total weight loss (%TWL) was used. Secondary outcomes were safety and comorbidity resolution.

      Results

      A 1:1 propensity score match yielded 3018 patient pairs. Average age and body mass index (BMI) were 34 ± 10 years and 33 ± 3 kg/m2, respectively, and 89% were women. Mean percentage of excess weight loss at 1, 2, and 3 years after ESG was 77.1% ± 24.6%, 75.2% ± 47.9%, and 59.7% ± 57.1%, respectively. Mean percentage of excess weight loss at 1, 2, and 3 years after LSG was 95.1% ± 20.5%, 93.6% ± 31.3%, and 74.3% ± 35.2%, respectively. The mean difference in %TWL was 9.7% (95% confidence interval [CI], 6.9-11.8; P < .001), 6.0% (95% CI, –2.0 to 9.4; P < .001), and 4.8% (95% CI, –1.5 to 8.7; P < .001) at 1, 2, and 3 years, respectively. Noninferiority was demonstrated at all follow-up visits. Fourteen ESG patients developed adverse events (.5%) versus 10 LSG patients (.3%). Comorbidity remission rates after ESG versus LSG were 64% versus 82% for diabetes, 66% versus 64% for dyslipidemia, and 51% versus 46% for hypertension, respectively. Eighty ESG patients (2.7%) underwent revision to LSG for insufficient weight loss or weight regain, and 28 had resuturing after primary ESG (.9%).

      Conclusions

      ESG induces noninferior weight loss to LSG with similar comorbidity resolution and safety profiles.

      Graphical abstract

      Abbreviations:

      BMI (body mass index), ESG (endoscopic sleeve gastroplasty), LSG (laparoscopic sleeve gastrectomy), MBS (metabolic/bariatric surgery), %TWL (percentage of total weight loss)
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      References

        • De Luca M.
        • Angrisani L.
        • Himpens J.
        • et al.
        Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).
        Obes Surg. 2016; 26: 1659-1696
        • National Institutes of Health
        NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.
        Ann Intern Med. 1991; 115: 956-961
        • Baltasar A.
        • Serra C.
        • Perez N.
        • et al.
        Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation.
        Obes Surg. 2005; 15: 1124-1128
        • Blanco D.G.
        • Funes D.R.
        • Giambartolomei G.
        • et al.
        Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass in cardiovascular risk reduction: a match control study.
        Surg Obes Relat Dis. 2019; 15: 14-20
        • Aminian A.
        • Chang J.
        • Brethauer S.A.
        • et al.
        ASMBS updated position statement on bariatric surgery in class I obesity (BMI 30-35 kg/m(2)).
        Surg Obes Relat Dis. 2018; 14: 1071-1087
        • Campos G.M.
        • Khoraki J.
        • Browning M.G.
        • et al.
        Changes in utilization of bariatric Surgery in the United States from 1993 to 2016.
        Ann Surg. 2020; 271: 201-209
        • Abu Dayyeh B.K.
        • Edmundowicz S.A.
        • Jonnalagadda S.
        • et al.
        Endoscopic bariatric therapies.
        Gastrointest Endosc. 2015; 81: 1073-1086
        • Alqahtani A.
        • Al-Darwish A.
        • Mahmoud A.E.
        • et al.
        Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients.
        Gastrointest Endosc. 2018; 89: 1132-1138
        • Alqahtani A.R.
        • Elahmedi M.
        • Alqahtani Y.A.
        • et al.
        Laparoscopic sleeve gastrectomy after endoscopic sleeve gastroplasty: technical aspects and short-term outcomes.
        Obes Surg. 2019; 29: 3547-3552
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Brethauer S.A.
        • Kim J.
        • el Chaar M.
        • et al.
        Standardized outcomes reporting in metabolic and bariatric surgery.
        Surg Obes Relat Dis. 2015; 11: 489-506
        • Arnett D.K.
        • Blumenthal R.S.
        • Albert M.A.
        • et al.
        2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
        J Am Coll Cardiol. 2019; 74: 1376-1414
        • Hedjoudje A.
        • Dayyeh B.A.
        • Cheskin L.J.
        • et al.
        Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2019; 18: 1043-1053
        • Lopez-Nava G.
        • Asokkumar R.
        • Bautista-Castaño I.
        • et al.
        Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?.
        Endoscopy. 2021; 53: 235-243
        • Abu Dayyeh B.K.
        • Rajan E.
        • Gostout C.J.
        Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity.
        Gastrointest Endosc. 2013; 78: 530-535
        • Neto M.G.
        • Silva L.B.
        • de Quadros L.G.
        • et al.
        Brazilian consensus on endoscopic sleeve gastroplasty.
        Obes Surg. 2021; 31: 70-78
        • Fayad L.
        • Adam A.
        • Schweitzer M.
        • et al.
        Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study.
        Gastrointest Endosc. 2018; 84: 782-788
        • Novikov A.A.
        • Afaneh C.
        • Saumoy M.
        • et al.
        Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: How do they compare?.
        J Gastrointest Surg. 2018; 22: 267-273
        • Mohan B.P.
        • Asokkumar R.
        • Khan S.R.
        • et al.
        Outcomes of endoscopic sleeve gastroplasty: How does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis.
        Endosc Int Open. 2020; 8: E558-E565
        • Sharaiha R.Z.
        • Kumta N.A.
        • Saumoy M.
        • et al.
        Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients.
        Clin Gastroenterol Hepatol. 2017; 15: 504-510
        • Pories W.J.
        • MacDonald Jr., K.G.
        • Morgan E.J.
        • et al.
        Surgical treatment of obesity and its effect on diabetes: 10-y follow-up.
        Am J Clin Nutr. 1992; 55: 582s-585s
        • Barrichello S.
        • Hourneaux de Moura D.T.
        • Hourneaux de Moura E.G.
        • et al.
        Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study.
        Gastrointest Endosc. 2019; 90: 770-780
        • Saumoy M.
        • Schneider Y.
        • Zhou X.K.
        • et al.
        A single-operator learning curve analysis for the endoscopic sleeve gastroplasty.
        Gastrointest Endosc. 2018; 87: 442-447

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